Clinical picture

Unusual skin manifestation of antiphospholipid syndrome A 30-year-old woman with antiphospholipid syn-drome (APS) was admitted for arthralgia, skin ulcer-ation (Figure 1) and auricular chondritis, 1 week after an intrauterine fetal death at 25th week of gestation. Physical examination showed a limited cutaneous necrosis of the neck as well as livedo, bilateral mild auricular chondritis and poly-arthralgia. Lab tests showed anti-DNA antibodies, and proteinuria 1 g/day. Kidney biopsy showed a non-proliferative lupus nephropathy. Skin biopsy of the neck lesion was consistent with thrombotic vas-culopathy with predominantly fibrin-rich micro thrombi in multiple small dermal vessels. No picture suggestive of vasculitis was observed. This skin lesion was then related to APS. Common skin mani-festations of APS are livedo reticularis, necrotizing vasculitis, thrombophlebitis, splinter haemorrhages, leg ulcers, distal cutaneous ischaemia, skin infarcts and acrocyanosis.1 The skin lesion reported here is therefore atypical although micro-thrombi of small dermal vessels are likely to be due to APS, and not to lupus. Photograph and text from: Bertrand Lioger